Trump Administration Cuts Spark Severe Global Health Disruptions for Pediatric HIV and Maternal Care

A sonar is performed on a pregnant woman at an AIDS care facility – partially funded by the President's Emergency Plan for AIDS Relief (PEPFAR) – in White River Junction, South Africa, in December 2008. Dr. Theopista Masenge was at the hospital in Mbeya, Tanzania, rolling out new treatments for children with high HIV viral loads when she got the call: Stop work, now.

It was January 2025, and the health care program the pediatrician was implementing, which provided services for HIV-exposed infants, children and pregnant women, had just received a letter from the now-dismantled United States Agency for International Development (USAID) directing it to halt all operations. “It was really, very abrupt, and I recall even the hospital managers were running up and down like, ‘What are we going to do?’” said Masenge, who lost her job not long after. Almost overnight, “the system that was built for almost 40 years was gone.”

“Everything has been disrupted,” she told CNN. More than a year later, she said that disruptions to HIV/AIDS services for children and pregnant women remain across Tanzania, even though limited US government funding has returned. It’s a pattern playing out across Africa, Asia and beyond as the Trump administration’s cuts to global health funding and dismantling of USAID have severely disrupted the United States’ flagship HIV/AIDS program, PEPFAR, according to a new study by the Foundation for AIDS Research (amfAR).

The study, conducted with Johns Hopkins University and published in July, surveyed 166 organizations that received PEPFAR funding last year across 46 countries (representing 23% of all PEPFAR partner organizations). Although the US government said last September that HIV services to prevent mother-to-child transmission would be prioritized and protected from funding cuts, the amfAR survey found that 63% of respondents reported disruptions to those services. That includes 22% of surveyed organizations that said they ended those mother-to-child prevention services entirely amid the funding cuts.

“Even if the administration’s intention was to not touch these programs, PEPFAR (funding) awards generally aren’t sort of specific to doing one individual task,” said Elise Lankiewicz, a senior policy associate at amfAR. “There was really no way to protect very singular parts of the system while dismantling others.”

It comes as 1,714 health clinics once supported by PEPFAR closed last year around the world, according to the organizations surveyed. “I’m not so worried in terms of supplies and medications, but I’m super worried about the quality of care for the children, for the mothers,” said Masenge, now the president of the Paediatric Association of Tanzania, regarding the situation in her area.

PEPFAR, which was established by the George W. Bush administration in 2003, is credited with saving more than 26 million lives and preventing millions of infections, mostly in Africa, according to the World Health Organization and the program’s own data. A US State Department spokesperson told CNN that the amfAR survey has “flawed” methodology and said that “the Trump Administration has strengthened PEPFAR through clear strategic direction, promoting greater recipient-country ownership, and sharpening the program’s focus on measurable health outcomes.”

The Elizabeth Glaser Pediatric Aids Foundation has called the drops in pediatric diagnosis and treatment an “HIV crisis hiding in plain sight,” noting that every single indicator in the pediatric HIV cascade shows decline. Despite US government carve-outs for life-saving work, amfAR’s analysis found that HIV testing for pregnant women declined slightly by 2% at the end of 2025, while testing for babies declined by at least 6%.